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Global study reveals soaring antibiotic resistance in India

By Andy Coghlan

(Klebsiella pneumoniae: the drugs no longer work (Image: AMI Images/SPL)

The first in-depth look at antimicrobial resistance worldwide has uncovered the extent to which antibiotics are misused, particularly in increasingly prosperous countries, including India, Vietnam and Kenya. The investigators say preventing resistance to existing antibiotics should take priority over developing new drugs, since they will also fail if the causes of resistance are not tackled.

The new analysis includes data on drug resistance in 39 countries, and profiles of antibiotic use in 69 countries, and is the first time such data has been combined. Previous reports have focused only on resistance, and included only data from public sources.

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“Much of this data has never seen the light of day before because we dug it out from private clinics in these middle-income countries like India,” says Ramanan Laxminarayan of the Center for Disease Dynamics, Economics and Policy in New Delhi, India. “It’s the first global snapshot of antibiotic use and resistance.”

The analysis reveals soaring rates of resistance in countries of growing wealth, especially India, where more people are demanding antibiotics for minor infections, and resistance rates among bacteria are soaring. “We’ve seen a huge increase in MRSA in India, from 29 per cent of isolates in 2009 to 47 per cent in 2014,” says Laxminarayan.

Equally alarming, he says, is a surge in Klebsiella pneumoniae, which can cause fatal lung infections. It is resistant to Carbapenems, an antibiotic that is used as a last resort. In 2014 57 per cent of samples tested in India were resistant, compared with virtually none six years ago. “These bugs weren’t a problem at all, but now we stand on the brink of almost losing a whole class of vital antibiotics,” says Laxminarayan.

Farm food

“This is an important report that underlines again the need for concerted action,” says Marc Sprenger, director of the World Health Organisation’s antimicrobial resistance secretariat. “The figures confirm the trends found in a WHO report in 2014 showing that antibiotic resistance is now a problem in every region of the world.”

The reason for the surge in India is similar to that in other countries that are now becoming more prosperous, such as Vietnam and Kenya. Citizens are taking antibiotics for minor infections, giving the bacteria more opportunities to evolve resistance.

To reverse the tide of resistance, the report recommends safeguarding the potency of existing antibiotics rather than focussing on developing new ones. “No matter how many new drugs come out, if we continue to misuse them, they might as well never have been discovered,” says Laxminarayan. He says around 95 per cent of resources for solving antibiotic resistance now go towards finding new drugs, but that this should be reduced to just 40 per cent.

“This report shows us again that reductions of antibiotic use in both human medicine and animal agriculture are necessary to stem the tide of resistance,” comments Carmen Dolores Cordova of the US Natural Resources Defense Council in San Francisco.

A crucial step would be phasing out the practice of routinely including mixtures of antibiotics in feed for livestock. This is often done simply to fatten up animals like pigs and poultry faster. “Roughly two-thirds of all antibiotics used globally are consumed in the farm sector,” says Laxminarayan. By far the largest farmyard consumption at present is in China, at around 15,000 tonnes in 2010, expected to double by 2030 as Chinese consumers demand more meat.

Other important ways to stop resistance from evolving and spreading include better hygiene and containment measures in hospitals, and halting the prescription of antibiotics for viral infections they can’t cure, such as colds.